Field of the invention
The present invention relates to an implant
designed to compensate for pathological changes or conditions
of bones and/or intervertebral discs and/or cartilage
and a method for its production.
Background of the invention
Implants for the treatment of pathological
conditions of the spine and/or locomotor system are known
in the prior art. They are intended, for example, to mechanically
stabilize a fracture, thus facilitating the
healing process or, in the case of endoprosthetic implants,
to be permanently bonded to the bone.
WO 98/19699 describes the systemic administration
of medications or hormones serving to promote
osteosynthesis and thus to accelerate the healing process
of the fracture. Examples of suitable means include
growth factors such as IGF-I. Such systemic applications,
however, can lead to undesirable side effects.
WO 93/20859 describes the fabrication of a
thin foil or film consisting of a polylactic
acid/polyglycolic acid copolymer containing growth factors.
The intent is to e.g. wrap such a foil around fracture-fixation
devices prior to their implantation with
the intent that the growth factors are released in localized
fashion in the area of the fracture. In practice,
however, this method is unsuitable since, for instance, a
nail wrapped with a foil of that type cannot be inserted
in the medulla in a way that the foil, which only loosely
envelops the nail, actually reaches the point of its intended
healing action.
US 2001/0031274 A1 discloses an implant for
pathological changes in the spinal column or locomotor
system comprising a varnish-like resorbable polymer coating
of a thickness of at most 100 µm including a growth
factor. Growth factors, however, have several drawbacks.
They are e.g. expensive and fast degraded, such that they
have a very limited effective time.
Hitherto statins such as lovastatin and simvastatin
that are 3-hydroxy-3-methylglutaryl coenzyme A
reductase inhibitors (see e.g. Rossouw et al. , N. Engl.
J. Med. 323, 1990) are well known as pharmaceutically active
agents that lower the cholesterin. In the last
years, they have also caused interest as having the capacity
of up-regulating the expression of the BMP-2 gene
in osteoblasts (see e.g. US 6,032,887 and US 6,376,476).
However, the literature on the bone forming/bone resorption
reducing abilities of statins is ambiguous (see e.g.
discussion of background art in US 6,022,887 and US
6,376,476 as well as documents cited there).
In light of the foregoing, a need exists for
an improved implant that promotes the healing process in
pathological changes of the spinal column and locomotor
system, especially by furthering osteosynthesis, and thus
accelerating the healing of fractures or the integration
of an implant, in particular an implant causing none or
at most minimal side-effects. It is in particular desired
to have an implant, especially a load-bearing implant,
that improves the healing process and provides advantages
in the production process.
Summary of the invention
The present invention relates to an implant
for treating pathological changes or conditions of bones
and/or intervertebral discs and/or cartilage, in particular
implants for regeneration and stabilization of the
anatomic features in case of bone fractures caused by external
force, osteotomy or pathological changes or conditions,
such as for the treatment of the spinal column,
for cranial and maxillo-facial applications, dental applications,
joint surgery, indications in hollow bones
(long bones) and extremities. Said implant comprises at
least one substance that induces the secretion of bone
and/or cartilage growth stimulating peptides such as
growth factors and/or bone morphogenetic proteins, in
particular at least one statin. In the scope of this invention,
a substance that induces the secretion of bone
and/or cartilage growth stimulating peptides is also referred
to as secretion inducing substance.
The implants, in particular the load-bearing
implants, can be made of metals including alloys, inorganic
non-metallic materials, polymers or combinations of
two or more materials of one of the above mentioned
groups of materials or of different groups of materials.
Usually, said implants exist as pre-formed bodies. It is,
however, also possible to make such implants of liquid or
viscous formable materials that cure after implantation
and that conserve the form they get at the place of implantation.
Although it is possible to incorporate a secretion
inducing substance in the implant body, in the
case of implants in the form of pre-formed bodies, the
implant preferably has a abrasion-resistant polymer coating
comprising said secretion inducing substance, in particular
said statin. Abrasion resistant refers to the
ability of the polymer coating to withstand abrasion during
handling and implantation.
In a preferred embodiment, said polymer coating
is resorbable. In general, the coatings of the present
invention have an average thickness of 50 µm or less,
preferably an average thickness of 25 µm or less, more
preferably 20 µm or less, and much desirably 15 µm or
less. Usually, the coating has an average thickness of at
least about 5 µm. Preferred implants are fracture- and/or
osteotomy-fixation device and/or endoprosthetic devices
and/or devices used for spinal non-fusion and fusion procedures
and/or dental implants and/or implants intended
for bone elongating procedures. Also comprised by the
present invention are e.g. devices for restauration of
cartilage. Examples of such preferred devices include
plates, screws, nails, pins, wires, threads, or cages.
Dependent on the intended effect and application,
the polymer used for the coating may have a glass
transition temperature of at least 37°C or below 37°C.
Independent of the glass transition temperature, the
polymer in general has a mean molecular weight of 100 kDa
or less, whereby for many applications suitable polymers
should have a mean molecular weight of at least 20 kDa. A
presently preferred molecular weight range is 25 to 35
kDa.
Examples of suitable polymers include poly-α-hydroxy
acids, polyglycols, polytyrosine carbonates,
starch, gelatins, polysaccharides, polyurethanes, polyesters,
polyphosphoesters, polyphosphates, polyphosphonates,
polyphosphites, modified proteins (e.g. fibrin,
casein), polyorthoesters, trimethylenecarbonates, polydioxanones,
polycaprolactones, and cellulose, as well as
blends and copolymers thereof. Examples of suitable poly-α-hydroxy
acids include polylactides, polyglycolic acids
and copolymers and blends thereof, whereby polylactides
are presently most preferred.
The coating encompassed by the present invention
includes at least one secretion inducing substance,
in particular at least one statin. Other pharmaceutically
active additives such as antibiotics, growth factors,
buffers etc. may be present in addition to the secretion
inducing substances, in particular the statins.
The present invention also relates to a
method of producing an implant having a usually abrasion-resistant,
in particular resorbable, polymer coating of a
thickness of usually 50 µm or less. Furthermore, the invention
relates to an implant produced by such a method.
The method for producing an implant includes the following
steps: preparing a dispersion of the optionally resorbable
polymer and the secretion inducing substance, in
particular the statins, in an appropriate solvent; applying
the dispersion on the surface to be coated; and allowing
the solvent to evaporate.
The term dispersion refers to any given distribution
of the polymer and the statin(s) in an organic
solvent. This may be a chemical solution, a purely physical
dispersion or any intermediate step, especially including,
for instance, colloidal solutions.
Appropriate solvents comprise organic solvents
and aqueous media, whereby for polylactides presently
organic solvents are preferred.
The application and evaporation processes may
occur, for example, at a temperature of between 0 and
30°C, and preferably at about 22°C. Additionally, the
evaporation of the solvent may occur, for example, in a
gaseous atmosphere substantially saturated with solvent
vapor. It has, however, been found that often such saturated
atmosphere is not necessary. In an exemplary embodiment,
the application of the dispersion and the
evaporation of the solvent are repeated two or more
times.
The dispersion may be filtered prior to its
application. Dependent on the particle size and the purity
desired, the filtering may occur through a conventional
filter or through a micropore filter with a pore
size of 0.45 µm or smaller. The secretion inducing substance(s),
in particular the statin(s) may be added together
with the polymer or at a later stage.
Suitable solvents include ethyl acetate or
chloroform with the dispersion containing, for example,
20 to 300 mg of polymer per ml of solvent.
In the case of liquid or viscous formable
"implants", the secretion inducing substance(s), such as
statins can be mixed with the curable materials or part
thereof. The secretion inducing substances, e.g. the
statin can be added impregnated on or incorporated into
an e.g. water-soluble filler that dissolves under the
conditions present at the implantation site, or they can
be mixed with a resorbable polymer.
Detailed description of preferred embodiments
In one aspect, the present invention relates
to an implant for the treatment of pathological changes
or conditions of bones and/or intervertebral discs and/or
cartilage, in particular implants for regeneration and
stabilization of the anatomic features in case of bone
fractures caused by external force, osteotomy or pathological
changes or conditions, such as for the treatment
of the spinal column, for cranial and maxillo-facial applications,
dental applications, joint surgery, indications
in hollow bones (long bones) and extremities,
wherein said implant comprises at least one substance
that induces the secretion of bone and/or cartilage
growth stimulating peptides such as growth factors and/or
bone morphogenetic proteins (secretion inducing substance),
in particular at least one statin.
In a preferred embodiment of this aspect, the
implant has an abrasion-resistant coating of a preferably
resorbable polymer that comprises at least one statin and
that usually has a thickness of up to 50 µm. As used
herein, the term implant refers to a device, which in the
process of a surgical procedure is at least partially introduced
inside the body. In an exemplary embodiment the
present invention is directed to implants of the type
that serve to support a pathologically changed spinal
column and/or locomotor system, especially by providing a
mechanical reinforcement. The pathological changes may be
in the form of fractures, pathological changes of joints
and bones. Application of the implants may involve direct
contact with, attachment to or insertion in a bone or
other part or element of the spinal column or locomotor
system.
The term implant is to be understood in the
broadest sense of the word since it also includes, for
instance, implants which are used for longative or reductive
osteotomies, craniotomies, for tumor and sports-injury-related
surgery, in dentistry as well as in the
case of oral, maxillary and facial dislocations.
The term fracture- and/or osteotomy-fixation
device refers to any device that serves to fix, correct
and/or mechanically stabilize a fractured bone and/or an
osteotomy. Examples thereof include plates, screws,
nails, pins, wires, threads, or cages for the spinal column
and locomotor system. Usually, fracture fixation devices
are removed after the fracture has healed, but in
certain circumstances, they may be permanently left in or
on the bone or they can be reabsorbed by the organism.
Endoprosthetic implants are designed to permanently remain
in the body and usually function as substitutes for
a natural body part such as a joint, a bone section or a
tooth.
Such implants are e.g. fracture- and/or osteotomy-fixation
devices and/or endoprosthetic devices,
with preferred fracture- and/or osteotomy-fixation devices
being selected from the group consisting of plates,
screws, nails, pins, wires, threads, and cages.
The implants according to one embodiment of
the invention are made of a base material that is chemically
and/or physically different from that of the coating.
In many cases, the base material may not be resorbable.
This implies that under physiological conditions,
where the implant is used and for the length of time during
which it is typically retained in the body, the base
material will not decay, corrode or in any other way
change its physiochemical state, or if it does, then only
with negligible deterioration of its desired effect. An
implant according to one aspect of the invention will in
many cases consist of a metal including alloys such as
stainless steel or titanium. Alternatively, the implant
may consist of a base material which is itself resorbable
or bioresorbable.
In accordance with one aspect of the present
invention, the implants are provided with an abrasion-resistant
coating. By the term abrasion-resistant (see
above) also the following characteristics usually are encompassed:
The coating bonds with the surface of the base
material with enough adhesive strength such that when the
implant is implanted, mechanical friction will not abrase
or otherwise damage the coating, or at least not to such
an extent as to affect or even destroy its physical effect,
as described in more detail further below. For example,
it is desired that a nail which is provided with
such coating can properly be driven into the bone without
any significant abrasion of the coating.
It is preferable that the average thickness
of the coating is 50 µm or less. For example, spots with
a thickness of more than 50 µm, occasioned by fluctuations
in the coating process, would be allowed.
The polymer of the coating preferably consists
of a resorbable (bioresorbable) polymer. This means
that, due to its exposure to the physiological conditions
prevailing in the area of the implant, it will progressively
degrade over a period of preferably several weeks,
months, or years, through molecular breakdown. These molecular
separation products and any other metabolites
display no or, at worst, only negligible toxicity and the
body should be able to metabolize or excrete all or at
least most of them.
It is also possible to use compositions of
resorbable polymers having different degradation rates.
Since many secretion inducing substances, in particular
the statins, are readily dissolved in organic solvents,
they can homogeneously be incorporated in fast degrading
and/or slowly degrading areas to ensure the desired release
profile.
Secretion inducing substances, preferably the
statins, in particular if used according to the present
invention, surprisingly showed several advantages over
the hitherto used growth factors. Statins are easily obtainable
in great quantities and reproducible quality.
They are soluble in preferred solvents and therefore can
be homogeneously distributed in large amounts thereby
enabling the generation of the optimal release profile.
Furthermore, contrary to growth factors, they are not degraded
at the intended place of action but only in the
liver. This provides the possibility to further improve
their effect by enhancing their residence time at the
place of activity by e.g. adjusting the pH. If e.g. a
polymer is used that decomposes to acidic products, a pH
buffering substance can be incorporated in amounts to adjust
the pH of the implantation site in view of minimal
inflammation of the site and desired residence time of
the statins on said site. Furthermore, statins are more
stable than growth factors such that sterilization, e.g.
by means of gas and/or irradiation, of the coated implant
is possible. This is a great advantage since coating in
aseptic conditions as preferred for growth factor comprising
coatings is not necessary. Furthermore, statins
influence the growth factor production process of the
cells such that one statin molecule can generate several
growth factor molecules, whereby these growth factors -
as a further advantage - are identical to the growth factors
of the treated individuals.
The statins used are preferably selected from
the group comprising atorvastatin, fluvastatin, lovastatin,
rovastatin, simvastatin, cerivastatin and mixtures
thereof, whereby simvastatin and lovastatin are
presently preferred. It has to be understood that the
term statin may also refer to a mixture of two or more
statins, although usually one statin is sufficient to get
the desired activity, life time and release properties.
The statin is usually applied in amounts of
0.5 to 20 % by weight of the coating.
The release time usually is much shorter than
the degrading of the polymer. Usually release times of a
few hours or days are desired while the degradation of
the polymer takes several days, months or even years.
The polymer is preferably selected from the
group comprising poly-α-hydroxy acids, polyglycols,
polytyrosine carbonates, starch, gelatins, cellulose as
well as blends and copolymers containing these components.
Particularly preferred among the poly-α-hydroxy
acids are the polylactides, polyglycolic acids, and their
copolymers and blends. One example of a suitable polylactide
is a racemic poly-D,L-lactide, especially one with a
molecular weight of about 30 kDa. Such racemic compounds
form an amorphous, abrasion-resistant layer on the surface
of the implant. The formation of crystalline polymer
structures in the coating and therefore an enantiomerically
pure lactide should preferably be avoided.
It is preferred that the resorbable polymer
coating comprises at least part, preferably all the secretion
inducing substance.
The implant, in particular the coating may
contain additional pharmaceutically active agents, such
as osteoinductive or biocidal or anti-infection substances.
Suitable osteoinductive substances include, for
example, growth factors as disclosed in US 2001/0031274
A1. However, while growth factors might positively influence
the healing process in an early stage, their presence
results in a much more critical sterilization process
and enhances the costs. Thus, in preferred embodiments,
no growth factors are present.
Other additional pharmaceutically active
agents are antibiotics such as aminoglycosides. If at all
included, they are usually applied in amounts of 5 to 15
% by weight based on the solid content of the coating.
The coating may also contain pH buffering, in
particular osteoconductive substances such as a calcium-phosphate
buffer, in particular beta-tricalciumphosphate
(TCP). This buffer preferably is present in amounts of
about 2 to about 5 % by weight. The pH buffering substances
often are hardly soluble in the solvents used.
Therefore, it is preferred to apply them as fine powders.
It has proved to be advantageous if the coating
is not applied all at once but in several steps leading
to several, at least two, layers of the resorbable,
in particular statin comprising polymer. These layers can
have same or different compositions.
Preferred implant materials are metals selected
from the group consisting of titanium, titanium
alloys, steel, cobalt-chromium alloys, tantalum, magnesium
or combinations of two or more materials of the same
or different type.
Alternatively, the implant of the present invention
comprises resorbable and non-resorbable polymers.
Resorbable polymers are in particular polylactides and/or
polylactide-co-glycolides. Non-resorbable polymers are
e.g. ultra high molecular weight polyethylene (UHMWPE),
polyether ether ketones (PEEK) or blends thereof. Optionally,
such polymer materials may be present together with
the other materials described above or ceramics.
Preferred ceramics of which the implant may
be made alone or in combination with polymers and/or metals
are e.g. selected from the group comprising Ca-P ceramics,
Ca-S ceramics, Si-O ceramics and mixtures
thereof.
This invention also relates to a method for
producing an implant of the type described above, which
may include the steps of:
a) Preparing a dispersion comprising the resorbable
polymer and the secretion inducing substance(s),
in particular statin(s), in a solvent; b) applying the dispersion on the surface to
be coated; and c) allowing the solvent to evaporate.
The application of the dispersion and the
evaporation of the solvent (steps b) and c)) preferably
take place at a temperature of between 0 and 30°C, and
more desirably at a room temperature of about 22°C. This
so-called cold coating also allows for temperature-sensitive
components to be applied on the implant together
with the polymer. Applying the dispersion is performed
preferably by immersing the implant in the dispersion.
Other ways of applying the coating, for example by
brushing, spraying, etc. are also possible. In addition
to the polymer and the statin(s), the dispersion may also
contain the aforementioned further pharmaceutically active
agents such as antibiotic(s) and/or buffer(s).
Dependent on the solvent (including solvent
mixtures) used, it may be preferable if the solvent is
allowed to evaporate in a gas atmosphere essentially
saturated with solvent vapor. In this case, the implant
that has been provided with the still solvent comprising
coating is transferred into a closed space whose atmosphere
is highly solvent-saturated. This will result in a
slowed down evaporation of the solvent, and consequently,
in a uniform, well-adhering abrasion-resistant coating.
During solvent-evaporation, dependent on the viscosity of
the coating layer after application, the intended evaporation
time and the desired uniformity of the thickness
of the coating, movement of the implant to compensate for
gravitation forces acting on the coating might be desirable.
The preferred evaporation time is between 1 minute
and 1 hour, or more preferably 5 to 30 minutes, and most
desirably about 10 minutes. It is also preferred to apply
the coating by incrementally building it up in several
thin layers, for example by repeating the application of
the dispersion (step b) and the solvent-evaporation processes
(step c) two or more times.
The solvents used preferably are popular organic,
non-polar or weakly polar solvents. Presently preferred
are ethyl acetate or chloroform with ethyl acetate
being especially preferred. Ethyl acetate can be evaporated
without solvent saturated atmosphere, i.e. in ambient
air. Furthermore, statins readily dissolve therein.
Prior to its application on the implant, the dispersion
contains secretion inducing substances and an amount of
preferably 20 to 300 mg, and more desirably 50 to 150 mg
polymer per ml of solvent and optionally other constituents
such as osteoinductive or biocidal substances.
Prior to the coating step b), the wettability
of the implant is preferably improved, e.g. by at least
once and preferably once immersing it into pure solvent.
A further aspect of the present invention enabled
by the better availability and stability of statins
over growth factors, is that they are also suitable to
not only be present in a coating but distributed all over
the implant. For example in case of a (nearly) totally
resorbable implant, statins distributed in the entire implant
body may be sufficiently slowly released to provide
an effect during the whole healing/implant degradation
process. Such implants can be solid or applied as liquid
or viscous formable compositions able to cure at the implantation
site. In the latter case, for slow release,
the statins may be homogeneously distributed within one
or several solids, e.g. buffers and/or resorbable polymers
that can be added as "fillers" to enhance the viscosity.
As already mentioned, the invention is especially
suitable for load bearing implants. It is, however,
not limited thereto. The implants can be applied
all over the skeleton of humans and animals. Preferred
applications are in the regeneration and stabilization of
the anatomic status in case of bone fractures and osteotomies
involving the hollow bones (long bones) of the
extremities, hands and feet, as well as the whole field
of oral and maxilla facial surgery and cranial surgery.
Further applications are in the scope of the spinal column.
These and other aspects of the present invention
may be more fully understood with reference to the
following non-limiting examples, which are merely illustrative
of presently preferred embodiments of the present
invention, and are not to be construed as limiting the
invention, the scope of which is defined by the appended
claims.
Example 1: Method for making spinal fusion
cage with a coating that induces the secretion of BMP-2.
A solution of 100 mg/ml of poly(D,L-lactide)
with an inherent viscosity of 0.5 dl/g in ethyl acetate
is prepared. After complete dissolution of the polymer 15
weight-% of simvastatin are added to the solution. The
clear solution is subsequently filtered with a 0.2 µm
filter and transferred into a cooled vessel.
A polyetheretherketone (PEEK) cage for spinal
fusion procedures is dipped into the solution and extracted
at a controlled speed. In order to avoid the accumulation
of solution in the internal spaces of the implant,
the implant is spun around its central axis immediately
after extraction from the coating solution. After
a drying time of at least two minutes this procedure is
repeated. This procedure yields an implant with a coating
that has the ability to stimulate the secretion of bone
growth factors in osteoblasts. The thickness of the coating
is preferably between 5 µm and 10 µm.
The implant obtained by the described method
can be used for spinal fusion procedures, bone formation
is increased by the release of simvastatin from the coating.
Implantation of the implant occurs by the standard
surgical procedure used also for uncoated spinal cages.
Example 2: Method for making an implant for
repair of intertrochanteric fractures with a coating that
induces the secretion of BMP-2.
A solution of 70 mg/ml of poly(D,L-lactide)
with an inherent viscosity of 0.5 dl/g in ethyl acetate
is prepared. After complete dissolution of the polymer 10
weight-% of simvastatin are added to the solution. The
clear solution is subsequently filtered with a 0.2 µm
filter and transferred into a cooled vessel.
A stainless steel implant for intertrochanteric
fracture repair (e.g. DHS® plate and DHS® screw by
Synthes®) is dipped into the solution and extracted at a
controlled speed. After a drying time of at least two
minutes this procedure is repeated. This procedure yields
an implant with a coating that has the ability to stimulate
the secretion of bone growth factors in osteoblasts.
The thickness of the coating is preferably between 10 µm
and 20 µm.
The implant obtained by the described method
can be used for the repair of intertrochanteric fractures,
in particular in the elderly, where bone metabolism
may be impaired. Bone formation is increased by the
release of simvastatin from the coating. Implantation of
the implant occurs by the standard surgical procedure
used also for uncoated DHS® plates and screws.
Example 3: Method for making an implant for
fixation of cranial segments after a craniotomy with a
coating that induces the secretion of BMP-2.
A solution of 100 mg/ml of poly(D,L-lactide)
with an inherent viscosity of 0.3 dl/g in ethyl acetate
is prepared. After complete dissolution of the polymer 15
weight-% of simvastatin are added to the solution. The
clear solution is subsequently filtered with a 0.2 µm
filter and transferred into a cooled vessel.
A titanium implant for fixation of cranial
segments (e.g. FlapFix™ by Synthes®) is dipped into the
solution and extracted at a controlled speed. After a
drying time of at least two minutes this procedure is repeated.
This procedure yields an implant with a coating
that has the ability to stimulate the secretion of bone
growth factors in osteoblasts. The thickness of the coating
is preferably between 10 µm and 20 µm.
The implant obtained by the described method
can be used for the fixation of cranial segments. Bone
formation is increased by the release of simvastatin from
the coating. Implantation of the implant occurs by the
standard surgical procedure.
While various embodiments of the present invention
are described above, it should be understood that
this invention is not to be limited to the specifically
preferred embodiments described herein.
Further, it should be understood that variations
and modifications within the spirit and scope of
the invention may occur to those skilled in the art to
which the invention pertains. Accordingly, all expedient
modifications readily attainable by one versed in the art
from the disclosure set forth herein that are within the
scope and spirit of the present invention are to be included
as further embodiments of the present invention.
The scope of the present invention is accordingly defined
as set forth in the appended claims.